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Suffering
Suffering, or pain in a broad sense,1 may be an experience of unpleasantness and aversion associated with the perception of harm or threat of harm in an individual.2 Suffering is the basic element that makes up the negative valence of affective phenomena. The opposite of suffering is pleasure, or happiness. Suffering is often categorized as physical3 or mental.4 It may come in all degrees of intensity, from mild to intolerable. Factors of duration and frequency of occurrence usually compound that of intensity. Attitudes toward suffering may vary widely, in the sufferer or other people, according to how much it is regarded as avoidable or unavoidable, useful or useless, deserved or undeserved. Suffering occurs in the lives of sentient beings in numerous manners, and often dramatically. As a result, many fields of human activity are concerned with some aspects of suffering. These aspects may include the nature of suffering, its processes, its origin and causes, its meaning and significance, its related personal, social, and cultural behaviors, its remedies, management, and uses. Terminology The word suffering is sometimes used in the narrow sense of physical pain, but more often it refers to mental pain, or more often yet to pain in the broad sense, i.e. to any unpleasant feeling, emotion or sensation. The word pain usually refers to physical pain, but it is also a common synonym of suffering. The words pain and suffering are often used both together in different ways. For instance, they may be used as interchangeable synonyms. Or they may be used in 'contradistinction' to one another, as in "pain is physical, suffering is mental", or "pain is inevitable, suffering is optional". Or they may be used to define each other, as in "pain is physical suffering", or "suffering is severe physical or mental pain". Qualifiers, such as physical, mental, emotional, and psychological, are often used for referring to certain types of pain or suffering. In particular, mental pain (or suffering) may be used in relationship with physical pain (or suffering) for distinguishing between two wide categories of pain or suffering. A first caveat concerning such a distinction is that it uses physical pain in a sense that normally includes not only the 'typical sensory experience of physical pain' but also other unpleasant bodily experiences including air hunger, hunger, vestibular suffering, nausea, sleep deprivation, and itching. A second caveat is that the terms physical or mental''should not be taken too literally: physical pain or suffering, as a matter of fact, happens through conscious minds and involves emotional aspects, while mental pain or suffering happens through physical brains and, being an emotion, involves important physiological aspects. The word ''unpleasantness, which some people use as a synonym of suffering or pain in the broad sense, may be used to refer to the basic affective dimension of pain (its suffering aspect), usually in contrast with the sensory dimension, as for instance in this sentence: "Pain-unpleasantness is often, though not always, closely linked to both the intensity and unique qualities of the painful sensation."5 Other current words that have a definition with some similarity to suffering include distress, unhappiness, misery, affliction, woe, ill, discomfort, displeasure, disagreeableness. Philosophy Hedonism, as an ethical theory, claims that good and bad consist ultimately in pleasure and pain. Many hedonists, in accordance with Epicurus and contrarily to popular perception of his doctrine, advocate that we should first seek to avoid suffering and that the greatest pleasure lies in a robust state of profound tranquility (ataraxia) that is free from the worrisome pursuit or the unwelcome consequences of ephemeral pleasures. For Stoicism, the greatest good lies in reason and virtue, but the soul best reaches it through a kind of indifference (apatheia) to pleasure and pain: as a consequence, this doctrine has become identified with stern self-control in regard to suffering. Jeremy Bentham developed hedonistic utilitarianism, a popular doctrine in ethics, politics, and economics. Bentham argued that the right act or policy was that which would cause "the greatest happiness of the greatest number". He suggested a procedure called hedonic or felicific calculus, for determining how much pleasure and pain would result from any action. John Stuart Mill improved and promoted the doctrine of hedonistic utilitarianism. Karl Popper, in The Open Society and Its Enemies, proposed a negative utilitarianism, which prioritizes the reduction of suffering over the enhancement of happiness when speaking of utility: "I believe that there is, from the ethical point of view, no symmetry between suffering and happiness, or between pain and pleasure. (...) human suffering makes a direct moral appeal for help, while there is no similar call to increase the happiness of a man who is doing well anyway." David Pearce, for his part, advocates a utilitarianism that aims straightforwardly at the abolition of suffering through the use of biotechnology (see more details below in section Biology, neurology, psychology). Another aspect worthy of mention here is that many utilitarians since Bentham hold that the moral status of a being comes from its ability to feel pleasure and pain: therefore, moral agents should consider not only the interests of human beings but also those of (other) animals. Richard Ryder came to the same conclusion in his concepts of 'speciesism' and 'painism'. Peter Singer's writings, especially the book Animal Liberation, represent the leading edge of this kind of utilitarianism for animals as well as for people. Another doctrine related to the relief of suffering is humanitarianism (see also humanitarian principles, humanitarian aid, and humane society). "Where humanitarian efforts seek a positive addition to the happiness of sentient beings, it is to make the unhappy happy rather than the happy happier. (...) Humanitarianism is an ingredient in many social attitudes; in the modern world it has so penetrated into diverse movements (...) that it can hardly be said to exist in itself."6 Pessimists hold this world to be mainly bad, or even the worst possible, plagued with, among other things, unbearable and unstoppable suffering. Some identify suffering as the nature of the world, and conclude that it would be better if life did not exist at all. Arthur Schopenhauer recommends us to take refuge in things like art, philosophy, loss of the will to live, and tolerance toward 'fellow-sufferers'. Friedrich Nietzsche, first influenced by Schopenhauer, developed afterward quite another attitude, arguing that the suffering of life is productive, exalting the will to power, despising weak compassion or pity, and recommending us to embrace willfully the 'eternal return' of the greatest sufferings.[citation needed] Philosophy of pain is a philosophical specialty that focuses on physical pain and is, through that, relevant to suffering in general. Religion Suffering plays an important role in a number of religions, regarding matters such as the following: consolation or relief; moral conduct (do no harm, help the afflicted, show compassion); spiritual advancement through life hardships or through self-imposed trials (mortification of the flesh, penance, ascetism); ultimate destiny (salvation, damnation, hell). Theodicy deals with the problem of evil, which is the difficulty of reconciling the existence of an omnipotent and benevolent god with the existence of evil: a quintessential form of evil, for many people, is extreme suffering, especially in innocent children, or in creatures destined to an eternity of torments (see problem of hell). The 'Four Noble Truths' of Buddhism are about dukkha, a term usually translated as suffering in the Dharma.7 Suffering is greatly defined in Buddhism and hold a key role in attaining the supreme bliss Nirvana. Understanding the nature of suffering, its cause, its cessation, and the way leading to its cessation (the Noble Eightfold Path) is the quintessential practice of Buddhism. Buddhism considers liberation from suffering (dukkha) and the practice of compassion (karuna)and mindfulness (Sati) as basic for leading a holy life and attaining the nirvana thus,elimination of suffering by attaining Buddhahood.8 Hinduism holds that suffering follows naturally from personal negative behaviors in one’s current life or in a past life (see karma in Hinduism).9 One must accept suffering as a just consequence and as an opportunity for spiritual progress. Thus the soul or true self, which is eternally free of any suffering, may come to manifest itself in the person, who then achieves liberation (moksha). Abstinence from causing pain or harm to other beings (ahimsa) is a central tenet of Hinduism. Suffering is thought to be an inclusive effect of human experience. Beyond this, Hindus are looking to achieve enlightenment and end human suffering by answering questions about life. This will lead to a unity in God as well as find the meaning of their suffering, ultimately achieving bliss. Christianity also believes that human suffering plays an important role in religion. Suffering is only to be thought of as a positive experience in the case of achieving a higher meaning of life, such as Jesus suffering for the lives of other people as was the case during the atonement. Suffering is the time to find God and value faith while doing so. This allows Christians to face reality of human experience with suffering and find an understanding in the divine. Hinduism and Christianity embrace similar aspects in suffering. Both religions realize the need for God as well as the moral significance for God that suffering provides. This allows enlightenment to be reached and suffering to be seen in the conditions that faith entails rather than an issue. These human experiences with suffering in both Hinduism and Christianity help educators to emphasize the need for dialogue and religious education in schools.10 In Islam, the faithful must endure suffering with hope and faith, not resist or ask why, accept it as Allah's will and submit to it as a test of faith (Allah never asks more than can be endured). One must also work to alleviate suffering of others, as well as one's own. Suffering is also seen as a blessing in Islam for the mankind . Through the gift of suffering the Veil of Forgetfulness is torn apart and the sufferer remembers God and connects with him. When people suffer God makes them think of him. Several Islamic Prophet Muhammad's traditions state that, suffering expunges the sins of mankind and cleanses their soul for the immense reward in afterlife. 11 The Bible's Book of Job reflects on the nature and meaning of suffering. It is supplemented in the Hebrew bible by the passages found in the Book of Isaiah and the Book of Jeremiah which elaborate the emotional and physical suffering of a conquered nation with its vanquished inhabitants forced into the suffering of exile and captivity in a foreign land.12 In the New Testament, suffering is portrayed both in the life of Jesus portrayed in the Synoptics, which narrate the suffering of the crucifixion, and in the post-Easter narratives. The suffering associated with punishment is further portrayed in the Apocalypse of John where suffering at the scene of the Last Judgment is depicted as the just recompense for sin and wrongdoing. Pope John Paul II wrote "On the Christian Meaning of Human Suffering".13 This meaning revolves around the notion of redemptive suffering. According to the Bahá'í Faith, all suffering is a brief and temporary manifestation of physical life, whose source is the material aspects of physical existence, and often attachment to them, whereas only joy exists in the spiritual worlds. In the words of `Abdu'l-Bahá, "All these examples are to show you that the trials which beset our every step, all our sorrow, pain, shame and grief, are born in the world of matter; whereas the spiritual Kingdom never causes sadness. A man living with his thoughts in this Kingdom knows perpetual joy. The ills all flesh is heir to do not pass him by, but they only touch the surface of his life, the depths are calm and serene." (Paris Talks, p. 110). Arts and literature Artistic and literary works often engage with suffering, sometimes at great cost to their creators or performers. The Literature, Arts, and Medicine Database offers a list of such works under the categories art, film, literature, and theater. Be it in the tragic, comic or other genres, art and literature offer means to alleviate (and perhaps also exacerbate) suffering, as argued for instance in Harold Schweizer's Suffering and the remedy of art.14 Landscape with the Fall of Icarus by Pieter Brueghel the Elder This Brueghel painting is among those that inspired W. H. Auden's poem Musée des Beaux Arts : About suffering they were never wrong, The Old Masters; how well, they understood Its human position; how it takes place While someone else is eating or opening a window or just walking dully along; (...) In Breughel's Icarus, for instance: how everything turns away Quite leisurely from the disaster; (...) 15 Social sciencesedit Social suffering, according to Arthur Kleinman and others, describes "collective and individual human suffering associated with life conditions shaped by powerful social forces".16 Such suffering is an increasing concern in medical anthropology, ethnography, mass media analysis, and Holocaust studies, says Iain Wilkinson,17 who is developing a sociology of suffering.18 The Encyclopedia of World Problems and Human Potential is a work by the Union of International Associations. Its main databases are about world problems (56,564 profiles), global strategies and solutions (32,547 profiles), human values (3,257 profiles), and human development (4,817 profiles). It states that "the most fundamental entry common to the core parts is that of pain (or suffering)" and "common to the core parts is the learning dimension of new understanding or insight in response to suffering".19 Ralph G.H. Siu, an American author, urged in 1988 the "creation of a new and vigorous academic discipline, called panetics, to be devoted to the study of the infliction of suffering",20 The International Society for Panetics was founded in 1991 to study and develop ways to reduce the infliction of human suffering by individuals acting through professions, corporations, governments, and other social groups.21 In economics, the following notions relate not only to the matters suggested by their positive appellations, but to the matter of suffering as well: Well-being or Quality of life, Welfare economics, Happiness economics, Gross National Happiness, Genuine Progress Indicator. In law, "Pain and suffering" is a legal term that refers to the mental distress or physical pain endured by a plaintiff as a result of injury for which the plaintiff seeks redress. Assessments of pain and suffering are required to be made for attributing legal awards. In the Western world these are typical made by juries in a discretionary fashion and are regarded as subjective, variable, and difficult to predict, for instance in the US,22 UK,23 Australia,24 and New Zealand.25 Biology, neurology, psychology Suffering and pleasure are respectively the negative and positive affects, or hedonic tones, or valences that psychologists often identify as basic in our emotional lives.26 The evolutionary role of physical and mental suffering, through natural selection, is primordial: it warns of threats, motivates coping (fight or flight, escapism), and reinforces negatively certain behaviors (see punishment, aversives). Despite its initial disrupting nature, suffering contributes to the organization of meaning in an individual's world and psyche. In turn, meaning determines how individuals or societies experience and deal with suffering. Neuroimaging sheds light on the seat of suffering Many brain structures and physiological processes are involved in suffering. Various hypotheses try to account for the experience of suffering. One of these, the pain overlap theory27 takes note, thanks to neuroimaging studies, that the cingulate cortex fires up when the brain feels suffering from experimentally induced social distress or physical pain as well. The theory proposes therefore that physical pain and social pain (i.e. two radically differing kinds of suffering) share a common phenomenological and neurological basis. According to David Pearce’s online manifesto The Hedonistic Imperative,28 suffering is the avoidable result of Darwinian genetic design. Pearce promotes replacing the pain/pleasure axis with a robot-like response to noxious stimuli29 or with gradients of bliss,30 through genetic engineering and other technical scientific advances. Hedonistic psychology,31 affective science, and affective neuroscience are some of the emerging scientific fields that could in the coming years focus their attention on the phenomenon of suffering. Health care Disease and injury may contribute to suffering in humans and animals. For example, suffering may be a feature of mental or physical illness such as borderline personality disorder3233 and occasionally in advanced cancer.34 Health care addresses this suffering in many ways, in subfields such as medicine, clinical psychology, psychotherapy, alternative medicine, hygiene, public health, and through various health care providers. Health care approaches to suffering, however, remain problematic. Physician and author Eric Cassell, widely cited on the subject of attending to the suffering person as a primary goal of medicine, has defined suffering as "the state of severe distress associated with events that threaten the intactness of the person".35 Cassell writes: "The obligation of physicians to relieve human suffering stretches back to antiquity. Despite this fact, little attention is explicitly given to the problem of suffering in medical education, research or practice." Mirroring the traditional body and mind dichotomy that underlies its teaching and practice, medicine strongly distinguishes pain from suffering, and most attention goes to the treatment of pain. Nevertheless, physical pain itself still lacks adequate attention from the medical community, according to numerous reports.36 Besides, some medical fields like palliative care, pain management (or pain medicine), oncology, or psychiatry, do somewhat address suffering 'as such'. In palliative care, for instance, pioneer Cicely Saunders created the concept of 'total pain' ('total suffering' say now the textbooks),37 which encompasses the whole set of physical and mental distress, discomfort, symptoms, problems, or needs that a patient may experience hurtfully. Relief and prevention in society Since suffering is such a universal motivating experience, people, when asked, can relate their activities to its relief and prevention. Farmers, for instance, may claim that they prevent famine, artists may say that they take our minds off our worries, and teachers may hold that they hand down tools for coping with life hazards. In certain aspects of collective life, however, suffering is more readily an explicit concern by itself. Such aspects may include public health, human rights, humanitarian aid, disaster relief, philanthropy, economic aid, social services, insurance, and animal welfare. To these can be added the aspects of security and safety, which relate to precautionary measures taken by individuals or families, to interventions by the military, the police, the firefighters, and to notions or fields like social security, environmental security, and human security. Uses Philosopher Leonard Katz wrote: "But Nature, as we now know, regards ultimately only fitness and not our happiness (...), and does not scruple to use hate, fear, punishment and even war alongside affection in ordering social groups and selecting among them, just as she uses pain as well as pleasure to get us to feed, water and protect our bodies and also in forging our social bonds."38 People make use of suffering for specific social or personal purposes in many areas of human life, as can be seen in the following instances: * In arts, literature, or entertainment, people may use suffering for creation, for performance, or for enjoyment. Entertainment particularly makes use of suffering in blood sports, violence in the media, or violent video games. A more or less great amount of suffering is involved in body art. The most common forms of body art include tattooing, body piercing, scarification, human branding. Another form of body art is a sub-category of performance art, in which for instance the body is mutilated or pushed to its physical limits. * In business and various organizations, suffering may be used for constraining humans or animals into required behaviors. * In a criminal context, people may use suffering for coercion, revenge, or pleasure. * In interpersonal relationships, especially in places like families, schools, or workplaces, suffering is used for various motives, particularly under the form of abuse and punishment. In another fashion related to interpersonal relationships, the sick, or victims, or malingerers, may use suffering more or less voluntarily to get primary, secondary, or tertiary gain. * In law, suffering is used for punishment (see penal law ); victims may refer to what legal texts call "pain and suffering" to get compensation; lawyers may use a victim's suffering as an argument against the accused; an accused's or defendant's suffering may be an argument in their favor; authorities at times use light or heavy torture in order to get information or a confession. * In the news media, suffering is often the raw material.39 * In personal conduct, people may use suffering for themselves, in a positive way.40 Personal suffering may lead, if bitterness, depression, or spitefulness is avoided, to character-building, spiritual growth, or moral achievement;41 realizing the extent or gravity of suffering in the world may motivate one to relieve it and may give an inspiring direction to one's life. Alternatively, people may make self-detrimental use of suffering. Some may be caught in compulsive reenactment of painful feelings in order to protect them from seeing that those feelings have their origin in unmentionable past experiences; some may addictively indulge in disagreeable emotions like fear, anger, or jealousy, in order to enjoy pleasant feelings of arousal or release that often accompany these emotions; some may engage in acts of self-harm aimed at relieving otherwise unbearable states of mind. * In politics, there is purposeful infliction of suffering in war, torture, and terrorism; people may use nonphysical suffering against competitors in nonviolent power struggles; people who argue for a policy may put forward the need to relieve, prevent or avenge suffering; individuals or groups may use past suffering as a political lever in their favor. * In religion, suffering is used especially to grow spiritually, to expiate, to inspire compassion and help, to frighten, to punish. * In rites of passage (see also hazing, ragging), rituals that make use of suffering are frequent. * In science, humans and animals are subjected on purpose to aversive experiences for the study of suffering or other phenomena. * In sex, especially in a context of sadism and masochism or BDSM, individuals may use a certain amount of physical or mental suffering (e.g. pain, humiliation). * In sports, suffering may be used to outperform competitors or oneself; see sports injury, and no pain, no gain; see also blood sport and violence in sport as instances of pain-based entertainment.